Exploring variable-based and case-based approaches to study multiple health behaviours and motivations of Canadian university students

Health behaviors tend to occur together. However, the research on what factors define and regulate their coexistence within individuals is still limited. There is also no established methodology to investigate regulation mechanisms of multiple health behaviours. The objectives of the study were to explore: 1) co-occurrence of multiple health behaviours (smoking, alcohol drinking, physical activity, and healthy eating) in a sample of Canadian university students; 2) the role of motivational (e.g., controlled, autonomous and intrinsic motivations), cognitive (e.g., health attitudes and health empowerment), and social contextual (e.g., family and friends) components in these regulation mechanisms; 3) the strengths and limitations of integrating variable-based and case-based methodological approaches to study the coexistence and regulation of multiple health behaviours. The research was based on the theoretical underpinnings of Self-Determination Theory (SDT) and a critical realism paradigm. College students (N==238) from the University of Saskatchewan completed a survey in Study 1. Six participants, purposefully selected from the sample were interviewed in Study 2. The most frequent multiple health behaviour cluster was ‘alcohol drinking+physical activity+healthy eating’ (62%; n=143). The results of multiple regression analysis (Study 1) confirmed that intrinsic and autonomous motivations were the best predictors of the frequency of alcohol consumption, physical activity, and healthy eating. Interview analyses in Study 2 also suggested that multiple health behaviours were best self-regulated when motivations were harmonized with individuals’ cognitions and emotions, and supported by their social contexts. Such balance could be achieved by exercising more self-control, making up for one health behaviour via another, or avoiding cognitive dissonance by ‘splitting up’ a negative concept into positive and negative ones (e.g., occasional smoking to release stress versus harmful chain smoking). Both Study 1 and Study 2 results present motivation as a hierarchical structure and provide evidence that motivational regulations across multiple health behaviours are interrelated. The comparative analysis of Studies 1 and 2 demonstrates that the integration of two different methodological approaches and the consilience between their results added to the validity and generalizability of the common findings. Importantly, contradictions in findings highlighted limitations of each methodological approach and were discussed in terms of implications for their methodological refinement